Why does this matter?The HEART score has become the dominant risk stratification scoring system for chest pain. However, several other scoring systems exist such as GRACE, TIMI, and EDACS. A prior prospective, multi-center comparison in the United States found EDACS to be the superior scoring system overall. But how would EDACS fare in a rematch? If you have trouble keeping track of these scores, try Evidence Care (low risk chest pain section written by Dr. Amal Mattu) or MDCalc.

“Don’t phunk with my HEART.” – Black Eyed PeasThis was a retrospective analysis of 118,822 patients in the Kaiser Permanente Northern California system. The clinical documentation was electronically processed to calculate the HEART and EDACS scores. Using cTnI </= 0.04 ng/ml (99th percentile), EDACS and HEART scores identified 66.5% and 56.2% of patients as low risk, respectively. NPV for MACE at 60 days was 99.12% and 99.32%, respectively.

This study then performed a second analysis. It challenged that a 98th percentile troponin may not be normal. Among all patients with cTnI 0.02-0.04 ng/ml, they had a roughly 5-fold increase in estimated MACE at 60 days. Using this lower threshold with EDACS and HEART score improved NPV to 99.49% and 99.55%, respectively.